Healthcare Provider Details

I. General information

NPI: 1851454524
Provider Name (Legal Business Name): RIMA JIBALY M.D. , P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2006
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 VILLA LINDE CT SUITE 38
FLINT MI
48532-3410
US

IV. Provider business mailing address

1123 VILLA LINDE CT SUITE 38
FLINT MI
48532-3410
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-7221
  • Fax: 810-733-7280
Mailing address:
  • Phone: 810-733-7221
  • Fax: 810-733-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4301069514
License Number StateMI

VIII. Authorized Official

Name: DR. RIMA JIBALY
Title or Position: PRESIDENT
Credential: M.D, B.S
Phone: 810-691-0171